What Are External Hemorrhoids?

Hemorrhoids are described as dilated sub-mucosal vascular tissue around the anal canal in their normal state that actually helps in the passage of flatus and controlling the bowel movements. They look like round to oval-shaped pink-bluish swellings lining the lower portion of rectum and anus. These clusters of veins are filled with blood supplied by six arteries in the rectal wall.

When due to certain risk factors, the pressure increases in the rectal veins weaken the connective tissue supporting these blood-filled arteries, leading to bleeding hemorrhoidal disease. 

Hemorrhoids are categorized according to their origin relative to the dentate line (anatomical structure), typically located about 3-4 cm nearer to the anal opening. Tissues that are below the dentate line are supplied by nerves that are more sensitive to pain and irritation.

When these form an abnormal bulge or lumps around the anus with easy self-identification, they are termed external hemorrhoids. Hence they are usually seen from the outside. Anatomically, External hemorrhoids originate below the dentate line, have a somatic supply of nerves that can cause pain.

Risk Factors & Causes  in External Hemorrhoids

The external types of hemorrhoids are caused by increased pressure in the rectal veins due to the weakening of the anal cushion and spasm of the internal sphincter or opening. 

Some of the most common external hemorrhoid causes are:

1. 3rd trimester of Pregnancy
2. Prolonged Constipation 
3. Long-lasting diarrhea
4. Heavy weight lifting
5. Being overweight or Obesity

Sign & Symptoms of External Hemorrhoids

Signs & symptoms may only flare up every few weeks, making it hard to know the real cause of the anal discomfort is actually hemorrhoid-related in the first place. Some symptoms included are:

1. External hemorrhoids are located in an area with nerve endings, responsible for the discomfort or pain, especially during bowel movements.
2. Continous nagging, itchy feeling around the anal area.
3. Mild, but consistent, itching around the rectal area.
4. Painful swelling or lumps around the verge of the anus.
5.  Bleeding with a bowel movement
6. Difficulty cleaning after a bowel movement
7. Fecal leakage

Many people with external hemorrhoids also have symptomatic internal hemorrhoids which can cause bleeding.

Thrombosed External Hemorrhoids

Thrombosed is a clinical term, which is formed by the pooling of blood, due to the stoppage of the blood supply from the rectal arteries to hemorrhoids, forming a hard bulge or lump around the anus and typically exhibiting acute pain & discomfort. 

Over time, increasing anal discomfort due to severe irritating causes like frequent itching, swelling, and pain that blocks the blood flow to the hemorrhoids, leading to blood pooling because of venous congestion in the affected area, resulting in the formation of acute blood thrombus or clot with a purplish hue. With a matter of a short period of time, around 1-4 days being the peak, the internal pressure increases, making the clotted lumps hard, firm, and discolored from the underlying clot, resulting in tightening of the muscles around the anus. This will make external hemorrhoids hard painful with a bluish tinge mostly after straining on the toilet.

External hemorrhoids being present in the sensitive anal region result in pain and bleeding with bowel movements. Because these hemorrhoids are well exposed to external friction too, they are more susceptible to further severe infection with routine activities such as sitting or walking. Taking preventive measures with diet & lifestyle, regular exercise along the guidance of an expert is a must for life without hemorrhoids.